- Associate's degree with three (3) years of relevant experience or five (5) years' experience in a related field or an equivalent combination of education and experience
- Knowledge of medical terminology
- Bilingual preferred
- Requires Strong Oral and Written Communication and Interpersonal skills
- Requires ability to make sound decisions under the limited direction of Supervisor
- Requires strong knowledge of managed healthcare business, within a primary care physician practice setting. One (1) or more years of actual relevant experience preferred.
- Strong proficiency in Microsoft applications including Outlook, Word, and Excel
- Proficiency with AllScripts; EHR preferred
- Demonstrated ability to analyze complex data and resolve problems with minimal supervision
- Excellent business judgment and time management/prioritization skills
- Intermittent Driver - Valid driver's license and automobile insurance per Company policy
- Satisfactorily complete competency requirements for this position.
- Represent the Company professionally at all times through care delivered and/or services provided to all clients.
- Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
- Comply with Company policies, procedures and standard practices.
- Observe the Company's health, safety and security practices.
- Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
- Use resources in a fiscally responsible manner.
- Promote the Company through participation in community and professional organizations.
- Participate proactively in improving performance at the organizational, departmental and individual levels.
- Improve own professional knowledge and skill level.
- Advance electronic media skills.
- Support Company research and educational activities.
- Share expertise with co-workers both formally and informally.
- Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
- Reviews daily referral and admission reports. Identifies status of Managed Care/Physician Office referrals (including Admissions, Referrals Not Admitted, and Deferred Admissions).
- Initiates the communication of new admissions, level of care changes and clinical updates to appropriate physician group case managers utilizing their preferred contact methods.
- Ensures all new patient admissions PCP, manage care group and health plan affiliations have been documented appropriately in EMR.
- Establishes and maintains relationships with managed care office designee, i.e., case manager, office manager, physician provider.
- Maintains and updates master list of managed care office designees, including names, phone numbers, email addresses and preferred contact methods including feedback from Clinical Liaisons and Managed Care partners.
- Reviews level of care changes of managed care patients, including clinical notes, as identified by ACE notification
- Ensures all managed care patient consents, advance directives, DNROs, clinical notes and initial assessment/guidelines are distributed to the appropriate managed care office designee, based on the preference of the Physician Group.
- Works with Business Development leadership, compiling monthly reports of all managed care patients for Physician groups as well as other key accounts as requested.
- Follows all policies and procedures and meets all HR and educational requirements.
- Participates and adheres to all quality improvement and compliance programs.
- Responsible for MyUnity documentation and account assignment per direction of the Business Development Directors.
- Performs other duties as assigned.
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managed care coordinator - Fort Myers, FL , USA, United States - Chapters Health System
Description
It's inspiring to work with a company where people truly BELIEVE in what they're doingWhen you become part of the Chapters Health Team, you'll realize it's more than a job. It's a mission. We're committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success
Role:
The Managed Care Coordinator (MCC) is responsible to coordinate and disseminate pertinent information regarding all Medicare Advantage, Managed Medicaid and large Managed Care provider patients.
In this role, the Managed Care Coordinator works with the Patient Support staff, Billing and Finance team, and Clinical Liaisons.
The MCC acts as a liaison between the Company and the Physician Group Case Managers. Creates and maintains relationships and communication with local area managed care groups and their case management professionals.The MCC is involved in organizing, tracking and reporting of key patient demographic information in a reporting tool for the managed care referral sources.
Qualifications:
Competencies:
Responsibilities of all employees:
Job Responsibilities:
This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.
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